Hepatitis C, though easily treated, is ignored in many jails

People who have been involved with the criminal justice system are more likely to have hepatitis. But while hepatitis C treatment is common in prisons, it is not in jails, which are usually run by local counties and incarcerate people for much shorter times. Estimates of hepatitis C antibodies among people incarcerated in county jails range between 12% and 35% in the United States.

From 2013 until the COVID-19 pandemic started in 2020, untreated hepatitis C infections were the number one cause of death in the U.S. from a nationally notifiable infectious disease. And although it’s easily cured, there are very minimal resources devoted to testing people for hepatitis C and making sure they receive treatment.

A new study led by Shelley Facente, Community Sciences assistant adjunct professor at UC Berkeley School of Public Health, suggests that jails in areas with high rates of hepatitis C infections—including San Francisco—should treat incarcerated people for the disease.

“Many people assume that since people in jail are often there a short time, it doesn’t make sense to treat them in jail, and they should just be referred at the time of release to treatment at another location out in the community,” says Facente. “However, the reality is that if not treated in jail, many people cycling in and out of the jail system are likely to remain untreated.”

In a paper published in the Journal of Correctional Health Care, Facente and colleagues found that while the median jail stay in San Francisco is two days, many stay much longer—79 out of the 320 people living with hep C while incarcerated between 2016 and 2021 were in jail for at least 8 weeks after their hep C was diagnosed, enough time for the full course of treatment.

Additionally, 56% of those in jail during this time period had hepatitis C that was still untreated. This percentage is much higher than in the city overall, which means that treating this population outside of jail is not working well, despite numerous community treatment options available in San Francisco.

“The evidence in this study suggests that what exists may be insufficient for a subset of people who are cycling in and out of jail, often while dealing with chaotic substance use and housing insecurity,” said Facente.

Interviews revealed that both jail staff and those incarcerated were enthusiastic about accessing treatment, and that many weren’t aware of opportunities for treatment in the outside community.

“Many of the people we interviewed in jail were excited about the prospect of accessing community based supports for hepatitis C treatment as if they were new ideas, when these services have existed for a long time without them benefiting or even being aware of their existence,” said Facente. “This points to a real opportunity for systems change.”

Facente would like to see the budgetary cap be lifted for treating people with hepatitis C in jail. She notes that San Francisco already automatically treats for HIV and STIs in jail, and this model should be extended to hepatitis C, especially in light of San Francisco’s groundbreaking hepatitis C elimination initiative that began a decade ago.

“Hep C is something we can cure, that spreads very easily, and that San Francisco has committed to eliminating,” Facente said. “For all those reasons, we should invest in getting people the treatment they need in the place that makes the most sense for them, and for a lot of people, that’s in jail.”